Sesamoiditis last year; got better over time. activity restarted and pain came back much worse,not improving (with pt); clean xray- stress fracture?

Time and patience: Sesamoiditis is notoriously difficult to treat. X-rays typically show a stress fracture, but some physicians opt for an MRI if pain continues. Differences in opinion are common on resting vs mild activity. You will want a rigid shoe and molded pads in the area to help. Ultimately, some patients need prolonged (few weeks) rest or a rigid boot/cast while the area heals.